Abstract: Background　Professional identity of general practitioners（GPs）can stimulate enthusiasm and initiative of GPs in primary health care.Driving forces of research and teaching and career expectations can affect the professional identity of GPs.However，their relationship and formation mechanism of professional identity are unclear.Objective　To explore the formation mechanism of professional identity of GPs，in order to provide effective incentive approaches of research and teaching for the improvement of GPs' professional identity.Methods　From September to November 2017，using stratified random sampling，we selected 397 GPs from community health centers in urban area，urban and rural intersections and suburbs of Shanghai.All of them were surveyed with 4 self-administered questionnaires，GPs' Basic Personal Characteristics Questionnaire，GPs' Self-perceived Driving Forces of Research and Teaching Scale （SDFRT），Career Expectation Scale （CES） and Professional Identity Scale （PIS）．On the basis of the survey results，we constructed a structural equation model （SEM） and tested it for the analysis of the formation mechanism of GPs' professional identity.Results　A total of 397 questionnaires were issued，383 of which were valid.The effective recovery rate was 96.5%.The mean scores of 4 dimensions of the SDFRT，resource support，organization management，performance incentive and innovation support，were （10.3±3.0），（11.4±2.9），（6.1±2.2），and （11.3±2.7），respectively.The mean scores of dimensions of career development，career achievement and work-life balance of the CES were （9.5±3.1），（6.7±1.9），and （6.8±1.8），respectively.The mean scores of 3 dimensions of the PIS，professional cognition，professional behavior and professional values were （10.5±3.0），（8.6±1.6），and （8.4±1.7），respectively.The mean scores of all the dimensions of the scales showed positive correlations （P<0.05） except that the mean score of career development presented no linear correlation with that of performance incentive and work-life balance （P>0.05）．Bootstrap analysis for the test of mediating effect showed that path coefficients from organization management，performance incentive and innovation support to professional cognition with career achievement，work-life balance as mediating variables did not include 0 in the 95% confidence interval （CI），indicating that mediating effects were significant.The results extracted from SEM showed that career expectation played a mediator role between organization management and professional identity completely，and played a mediator role between performance incentive，innovation support and professional identity partly.Organization management had mild positive effects on professional identity.Performance incentive positively influenced professional cognition，but negatively influenced both professional behavior and professional values.Innovation support produced strong positive effects on each dimensions of the PIS.Conclusion　The career expectation plays a mediator role between research and teaching driving forces and professional identity partly.Community health centers are suggested to strongly support the innovative research and teaching work of GPs，ensure the equity of resource allocation and management system，and improve the performance evaluation mechanism.

Key words: General practitioners, Research and teaching driving forces, Career expectation, Professional identity, Structural equation model, Performance incentive

摘要： 背景　全科医生职业认同感的形成有助于激发其对基层医疗卫生工作的积极性和主动性。科教驱动和职业期望可以影响全科医生职业认同感的形成，但三者之间的相关性及全科医生职业认同感的具体形成机制尚不明确。目的　探索全科医生职业认同感的形成机制，为提高全科医生职业认同感提供有效的科教激励策略。方法　采用分层抽样法于2017年9—11月选取上海市区、城郊结合部、郊区社区卫生服务中心的全科医生397例，采用全科医生个人基本信息调查表、全科医生科教驱动感知量表、职业期望量表、职业认同感量表进行问卷调查，根据调查结果，构建全科医生职业认同感形成机制的结构方程模型，并进行检验。结果　共发放问卷397份，有效问卷383份，有效回收率为96.5%。科教驱动感知量表：资源保障得分为（10.3±3.0）分，组织管理得分为（11.4±2.9）分，绩效激励得分为（6.1±2.2）分，创新支持得分为（11.3±2.7）分；职业期望量表：职业发展得分为（9.5±3.1）分，职业成就得分为（6.7±1.9）分，工作生活平衡得分为（6.8±1.8）分；职业认同感量表：职业认知得分为（10.5±3.0）分，职业行为得分为（8.6±1.6）分，职业价值观得分为（8.4±1.7）分。除职业发展得分与绩效激励得分、工作生活平衡得分无直线相关关系（P>0.05）外，其余各量表维度得分间均呈正相关（P<0.05）。中介效应显著性检验的Bootstrap分析结果显示，以职业成就、工作生活平衡为中介变量，组织管理、绩效激励和创新支持对职业认知路径的95%CI均未包括0，中介效应显著。结构方程建模结果显示职业期望在组织管理对职业认同感的影响过程中起完全中介作用，在绩效激励、创新支持对职业认同感的影响过程中起部分中介作用。组织管理因素对职业认同感有较弱的正向影响；绩效激励因素对职业认知存在正向影响，对职业行为和职业价值观存在负向影响；创新支持因素对职业认同感的各维度有较强的正向影响。结论　科教驱动可通过职业期望的部分中介作用影响全科医生职业认同感。社区应大力支持全科医生的科教创新工作，保证资源分配和管理制度公平，并完善绩效考核机制。

关键词: 全科医生, 科教驱动, 职业期望, 职业认同感, 结构方程模型, 绩效激励